HomeMy WebLinkAboutDrain Layers Permit 406 Quarry Brook Dri TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5 11
19
Pursuant to written application, permission is hereb granted to t e License Dra n Layer
named herein to perform the work indicated bejow at
at premises owned by `yam w ose address is
and to
Lay House Drain, Repair House,Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS '
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy .4e he name of tye Town of South Windsor:
Engineering Department Dater
Connection Charge Paid Permit Fee; Paid $
Check Number
Issued by -
Tax Office
INSPECTION
Date work started --Date completed
Sufficient notification received: es No
Special Conditions ,
APPROVED:" -2
Inspector Date